Technical Note

Kidney International (1995) 48, 244–250; doi:10.1038/ki.1995.290

Theory and validation of access flow measurement by dilution technique during hemodialysis

Nikolai M Krivitski1

1Transonic Systems Inc., Ithaca, New York, USA

Correspondence: Nikolai Krivitski PhD, Transonic Systems Inc., 34 Dutch Mill Rd., Ithaca, New York 14850, USA.

Received 14 December 1994; Revised 13 February 1995; Accepted 13 February 1995.

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Abstract

Access blood flow is currently measured by color-coded duplex sonography which has the ability to select groups of patients with higher risk of access failure [1]. There are also reports of operator errors [2] and of precision limitations arising from random uncertainties in the measurement of vessel diameter and Doppler angle [3]. Color-coded duplex sonography is an expensive technique and measurements are made only rarely. The onset of reduced flow can therefore be missed.

We recently reported a modification of the indicator dilution method for measuring access flow during hemodialysis [4] and the initial clinical use of this method [5]. This paper presents the theory and bench validation for this new access flow measurement technique.

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References

  1. Sands J, Young S, Miranda C: The effect of Doppler flow screening studies and elective revisions on dialysis access failure. ASAIO J 38:524–527, 1992
  2. Wittenberg G, Lundwehr P, Moll R, Tschammler A, Buschmann B, Krahe T: Interobserver variability of dialysis shunt flow measurements using color coated duplex sonography. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 154:375–378, 1993
  3. Oates CP, Williams ED, McHugh MI: The use of Diasonics DRF400 duplex ultrasound scanner to measure volume flow in arteriovenous/fistulae in patients undergoing hemodialysis: An analysis of measurement uncertainties. Ultrasound Med Biol 16:571–579, 1990 | Article | PubMed | ChemPort |
  4. Krivitski NM: Novel method to measure access flow during hemodialysis by ultrasound dilution (UD). (abstract) ASAIO in press
  5. Depner TA, Krivitski NM: Clinical measurement of blood flow in hemodialysis access fistulae and grafts by ultrasound dilution. (abstract) ASAIO in press
  6. Guyton AC: Textbook of Medical Physiology (6th ed). Philadelphia, Saunders, 1981, p 287
  7. Krivitski NM: Cardiac output measurement in extracorporeal systems by ultrasound velocity dilution. (abstract) ASAIO 82:1994
  8. Drost CJ: Vessel diameter-independent volume flow measurements using ultrasound. Proc San Diego Biomed Symposium 17:299–302, 1978
  9. Schneditz D, Kenner T: A sound-speed sensor for the measurement of total protein concentration in disposable, blood perfused tubes. J Acoust Soc Am 86:2073–2081, 1989
  10. Krpan D, Demarin V, Prot F, Milutinovic S, Molnar V, Milutinovic E: Measurement of blood flow through AV-fistulae by means of Doppler sonography in regularly hemodialyses patients. Int J Artif Organs 14:78–82, 1991

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